ABSTRACT
OBJECTIVES: To improve the quality of care provided to hospitalized children having acute lower respiratory infections (ALRI), to increase the knowledge on this health condition, and to broaden the utilization of health care resources through a program called "Winter Plan". METHODS: The program comprised the use of guidelines for diagnosis and treatment, disease-oriented hospitalizations to provide an increased level of care, management of health care resources and implementation of computerized medical records. Systematic investigation of viral etiology was performed in order to rationalize the use of medications and reduce nosocomial infections. RESULTS: During program implementation (19/V-19/IX/99), 3,317 children were admitted; 1,347 (40.61%) had ALRI, of which 1,096 (81%) were included in the study. Of them, 71% aged less than 1 year. Most ALRI were viral (68%). Admission criteria were: oxygen saturation <95%, tachypnea, retractions or pleural effusion (92.4% of the children). The demand magnitude prevented compliance with isolation guidelines in all cases. Treatment guidelines were followed in a high percentage of cases: 73% of children having bronchiolitis and 72% of those with viral pneumonia received no antibiotics and 96% of children with bacterial pneumonia were put on antibiotics as recommended; use of bronchodilators and corticosteroids was reduced. Medication costs were reduced especially in the corticosteroid group, which meant a greater impact on hospitalization costs. CONCLUSIONS: To decrease ALRI morbidity and mortality there is a need to continue improving the quality of health care during hospitalization and to reinforce health promotion actions and preventive programs at the primary level.
Subject(s)
Delivery of Health Care , Hospitalization/statistics & numerical data , Quality of Health Care , Respiratory Tract Infections/epidemiology , Acute Disease , Adolescent , Age Distribution , Child , Child, Preschool , Female , Health Planning , Humans , Infant , Male , Respiratory Tract Infections/therapy , Seasons , Uruguay/epidemiologyABSTRACT
La traqueostomía es una técnica utilizada en las unidades de cuidados intensivos de adultos y niños. Las indicaciones en pediatría para algunas situaciones están claramente establecidas, pero la decisión y oportunidad de realizarla es muchas veces discutida y diferida, más aún si el paciente es pequeño. Objetivo: evaluar la indicación de la traqueostomía en la UCI pediátrica. Material y método: Se estudiaron 43 pacientes ingresados por diferentes enfermedades en un periodo de tres años en la Unidad de Cuidados Intensivos de Niños del Centro Hospitalario Pereira Rossell, que requirieron traqueostomía. Resultados: La incidencia de traqueostomía en el período analizado fue del 2%. La causa más frecuente que determinó la realización de la misma fue la obstrucción de vía aérea superior postintubación endotraqueal (58%). Se realizó endoscopía previa en 15 de los 43 pacientes y resultó patológica en todos los casos. No hubo mortalidad vinculada a la técnica. En 70% de los pacientes se logró retirar la ventilación mecánica dentro de las 48 horas siguientes a la realización de la traqueostomía.
A traqueotomia é uma técnica utilizada na Unidade de Cuidados Intensivos de adultos e crianças . As indicações em pediatria para algumas situações estão claramente estabelecidas ,porém,a decisão e oportunidade de realizá-la ,muitas vezes é discutida e diferida ainda mais se o paciente for pequeno. Objetivo: avaliar a indicação da traqueotomia numa UCI pediátrica e analisar se existem fatores que a favorecem. Material e método: trabalho prospectivo ,descritivo de 3 anos ao qual ingressaram todos os pacientes aos quais lhes foi praticada a mesma após o ingresso à UCIN , CTI pediátrico polivalente do Centro Hospitalario Pereira Rossell de Montevidéu , Uruguai. Resultados: a incidência de traqueotomia no período analisado foi de 2%. A causa mais freqüente que determinou a realização da mesma foi a obstrução da via áerea superior após a instalação da cânula endotraqueal (58%). A endoscopia prévia foi realizada em 15 dos 43 pacientes sendo patológica em todos os casos. A complicação mais freqüente foi a obstrução da cânula por secreções . Não houve mortalidade vinculada à técnica. No 70% dos pacientes a desconexão da AVM foi nas primeiras 48 horas de realizado o procedimento.
Tracheostomy is a technique used in Pediatric and Adult Intensive Care Units. In pediatric patients the indications of tracheostomy are clearly established but the final decision and the opportunity is frequently a discussed and deffered, more so if the patient is small. Objective: evaluate the indication of the tracheostomy in a Pediatric Intensive Care Unit. Material and methods: we studied 43 patients who required tracheostomy, affected by different clinical conditions, during a three year period, at the Childrens Intensive Care Unit at the Centro Hospitalario Pereira Rossell. Results: the incidence of tracheostomy during the study period was 2%. The most frequent cause that determined the need for the procedure was upper airway obstruction post endotracheal intubation (58%). An endoscopy was performed prior to the procedure in 15 of the 43 patients and it was reported as pathological in all cases. The mortality related to the procedure was nil. In 70% of the cases mechanical ventilation was ended within the 48 hours after performing the tracheostomy.
